Why Inhaled Corticosteroids Fail in Severe Asthma
Most people with asthma can be effectively treated. But for some, medications that usually help don’t seem to work. Now U.S. researchers collaborating with those from Genentech believe they know why: growth factors stand in the way.
The investigators collected bronchial airway epithelial cells (BAECs) samples from asthma patients with severe asthma, those with moderate asthma, and healthy volunteers, then conducted a genetic analysis on the samples to determine which genes had been turned “on” in the BAECs. All of the BAECs collected from the asthma patients had been exposed to inhaled corticosteroids.
The analysis revealed that only the cells from the patients with severe asthma produced two growth factors that could block the inhaled corticosteroids from doing their job, fibroblast growth factor and granulocytic colony forming growth factor.
“We believe this response explains why patients with severe asthma are unresponsive to such conventional therapy,” said study author Reynold Panettieri, Jr., a professor of medicine at Rutgers Robert Wood Johnson Medical School.
The study was published by Science Translational Medicine. Read More
Lingering Inflammation in COVID-19 Patients May Call for Oral Steroids
Ongoing inflammation may be leading to deaths in people who have been hospitalized with COVID-19, report researchers from the University of Florida who looked at the electronic health records of 1,207 people who had been hospitalized with the virus in 2020 and 2021 and then followed for at least a year after discharge.
The investigators examined their levels of C-reactive protein (CRP) during hospitalization and over time to see how it correlates with outcomes. Results showed a strong correlation between CRP and the level of care needed during hospitalization, with the highest levels seen in those who required invasive ventilation or ECMO and the lowest in those who did not need supplemental oxygen.
Those in the highest CRP group had a 61% higher risk of dying from any cause during the year after they left the hospital. But the good news from the study is that those who were prescribed anti-inflammatory steroids after discharge had that risk lowered by 51%.
The researchers believe these findings suggest best practice should be changed to include more widespread use of oral steroids for some COVID-19 patients.
They also suggest COVID-19 might need to be reclassified as a chronic disease. “Once we recognize the importance of ‘long Covid’ after seeming ‘recovery,’ we need to focus on treatments to prevent later problems, such as strokes, brain dysfunction, and especially premature death,” said study author Professor Arch G. Mainous III.
The study was published by Frontiers in Medicine. Read More
Lung Health Study in Millennials Getting Underway
The American Lung Association (ALA) is launching a new study aimed at gauging the lung function of millennials. The research, which is now enrolling the first participants at Northwestern Medicine, will ultimately involve 4,000 young adults between the ages of 25 and 35 who will be followed for five years.
Participants will undergo pulmonary function testing and will be tracked for respiratory symptoms, along with demographic data. Low dose CT scans will be performed as well to look for intermediate lung injury or abnormalities.
Other facilities that will participate in the research include Johns Hopkins Hospital, Brigham and Women’s Hospital, the University of Michigan, the University of Alabama-Birmingham, Beth Israel Deaconess Medical Center, and all of the ALA’s Airways Clinical Research Centers.
“Due to the persistent COVID-19 pandemic, lung disease is now a leading cause of death in the U.S., and lung cancer is still the leading cause of cancer death, which is why this groundbreaking study comes at a time where lung health is more important than ever,” said ALA President and CEO Harold Wimmer. “This study is critical to our work to help people diagnose lung disease earlier and also work to prevent it.” Read More
JUUL Led to a Surge in Youth Smoking
The introduction of flavored e-cigarettes made by JUUL led to an increase in the number of young people using tobacco products not seen since the 1990s, say researchers from UC San Diego. They used data from a nationally representative sample to assess youth and young adults ages 14 to 34 years in 2014, before the surge in the use of JUUL products, and then again in 2017 during the JUUL surge.
For five age groups, the researchers compared how many participants used tobacco for the first time and how many became daily tobacco users over a two-year period. Although the number of individuals who tried cigarette smoking or became daily cigarette smokers dropped between the two time periods, 14- to 17-year-olds in the 2017 cohort had a 3.6-fold higher rate of progression to daily e-cigarette use than those in the 2014 cohort.
Two-thirds of all new daily tobacco users were in the 14 to 17 year age group in 2017 as well. In addition, new daily e-cigarette vapers who were underage had tobacco dependence scores similar to those of new daily cigarette smokers.
“Our analysis translates to 2,284 new under-aged daily tobacco users each day between 2017 and 2019,” said study author John P. Pierce, PhD. “This rate of youth tobacco initiation has not been seen since the early 1990s, prior to the implementation of tobacco control measures.”
The study was published by Pediatrics. Read More
Pulmonary Fibrosis Foundation Shared New Research at ATS 2022
The Pulmonary Fibrosis Foundation (PFF) presented the results of four studies during ATS 2022 in mid-May —
“Differences in Patient Outcomes Across the PFF Care Center Network” found variation in key clinical outcomes across the sites, suggesting a need for further research to identify the practice patterns and resources that are associated with improved outcomes.
“Hospitalization Rates in Various Interstitial Lung Diseases: An Analysis of the Pulmonary Fibrosis Foundation (PFF) Patient Registry” showed similar hospitalization rates between ILD subtypes. An increased risk of death or transplant was seen in hospitalized patients across the board. The risk of death or transplant was highest following hospitalization in patients with IPF and lowest in those with non-IPF idiopathic interstitial pneumonia.
“Visual and Quantitative CT Derived Parameters Predict Transplant-Free Survival in Patients with Interstitial Lung Disease: Results from the Pulmonary Fibrosis Foundation Registry” explored the relationship between CT pattern, fibrosis extent, and transplant-free survival in patients with usual interstitial pneumonia (UIP), finding that a definite UIP pattern and the extent of fibrosis scored by data-driven textural analysis are predictors of transplant-free survival in a heterogeneous group of patients diagnosed with ILD.
“Comparison of Interstitial Lung Disease Diagnoses in Urban and Rural Areas Among Patients in the Pulmonary Fibrosis Foundation Patient Registry” found a higher prevalence of hypersensitivity pneumonitis and exposure-related ILDs in ILD patients who live in rural areas. These were also associated with certain types of fuel use, leading the investigators to conclude that coal and wood fuel use may explain the different types of ILDs found in patients who live in rural areas.
The PFF Care Center Network, a group of 68 medical centers nationwide that specialize in the multidisciplinary care of individuals living with PF, was used in another study,” Discordance in Actual Versus Perceived Access to Palliative Care Services for Pulmonary Fibrosis Foundation Care Centers.” This study found a significant discordance between provider-reported and actual access to local outpatient and inpatient palliative care services for these patients. Read More
RSV Most Deadly in Middle and Low Income Countries
According to British researchers publishing in The Lancet, the respiratory syncytial virus (RSV) caused more than 100,000 child deaths in 2019. Overall, RSV was responsible for one in 50 deaths in children under age five and one in 28 deaths among those under six months.
Nearly half of the deaths were in babies less than six months old, and 97% of occurred in low and middle-income countries.
“With numerous RSV vaccine candidates in the pipeline, our estimates by narrower age ranges help to identify groups that should be prioritized, including pregnant people, so that children in the youngest age groups can be protected, similarly to current strategies which offer vaccines for whooping cough, typhoid, and tetanus to pregnant people,” said study author Harish Nair, from the University of Edinburgh. Read More
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